| NPI | 1659131811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN1000747) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS044594) |
| Enumeration Date | 2024-03-22 |
| Last Update Date | 2025-06-13 |